In this prospective observational cohort, researchers derived and validated a decision rule to predict true bacteremia in 3730 ED patients who had blood cultures drawn (abstract). They determined that patients should get a blood culture if they had at least 1 major or 2 minor criteria (Major criteria were temp>39.5, indwelling vascular catheter, or clinical suspicion of endocarditis; Minor criteria were temp 38.3-39.4, age >65, chills, vomiting, SBP<90, WBC>18, PMN>80%, bands>5%, platelets>150, or creatinine>2). Using these criteria in the validation set, the decision rule had a NPV of 99% (of patients without criteria, <1% actually had bacteremia), indicating its value in identifying those that DO NOT need a blood culture. However, it could not accurately identify those that DO need a blood culture (with a PPV of only 11%, a large number of patients with criteria would not be bacteremic).
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